Healthcare service utilization and cost among transition-age youth with autism spectrum disorder and other special healthcare needs.
Transition-age youth with autism rack up more doctor visits, therapy, and drug costs than peers with ADHD or typical development.
01Research in Context
What this study did
Hamama et al. (2021) tracked doctor visits, therapy hours, and drug prescriptions for 14- to young learners. They compared three groups: youth with autism, youth with ADHD, and youth with neither diagnosis.
The team pulled insurance claims for one full year. They counted every primary-care, mental-health, and OB/GYN visit. They also added up the dollars paid by the plan.
What they found
Autistic youth had the busiest calendars. They went to primary care twice as often as peers with ADHD. Mental-health visits and psychotropic meds were also highest in the ASD group.
Price tags followed the same pattern. ASD teens and young adults cost the plan more than the ADHD or typical groups. One surprise: autistic females had fewer OB/GYN visits than expected.
How this fits with other research
Bush et al. (2021) looked at younger kids and found the same price jump. Their 3- to young learners with ASD added about $4-6k per year. Together the two studies show the cost gap starts early and lasts into adulthood.
Yamashiro et al. (2019) and Mahé et al. (2025) followed the medication trail further. They saw heavy psychotropic use continue after age 18. The new data plug the gap, proving the surge begins in the transition years.
Sutton et al. (2022) give a warning: when COVID-19 shut clinics, adaptive skills in autistic young adults tanked. High service use in L et al. makes sense—remove it and clients lose ground fast.
Why it matters
If you write transition plans, budget for lots of moving parts—therapy, meds, primary care. Use these numbers when you ask insurance or state funds for extra hours. Also flag females who miss OB/GYN care; build reminders into their self-advocacy goals.
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02At a glance
03Original abstract
Youth with autism spectrum disorder often have complex medical needs. Disruptions of healthcare during the transition from pediatric to adult healthcare may put youth with autism spectrum disorder at higher risk of medical emergencies and high medical costs. To understand healthcare utilization during the transition years, we conducted a study among transition-age youth (14-25 years old) receiving healthcare at Kaiser Permanente Northern California during 2014-2015. We examined differences in healthcare utilization and costs among youth with autism spectrum disorder (n = 4123), attention deficit and hyperactivity disorder (n = 20,6015), diabetes mellitus (n = 2156), and general population controls (n = 20,615). Analyses were also stratified by age and sex. Youth with autism spectrum disorder had the highest utilization of outpatient primary care, mental health, and psychotropic medications and the lowest utilization of obstetrics/gynecology and urgent care. Costs for youth with autism spectrum disorder were higher than those for attention deficit and hyperactivity disorder and general population peers and lower than for diabetes mellitus. Healthcare utilization patterns varied by age. Transition-age youth with autism spectrum disorder generally used healthcare at higher rates relative to attention deficit and hyperactivity disorder and general population peers but at similar or lower rates than diabetes mellitus peers, indicating this group's complex combination of psychiatric and medical healthcare needs. The relatively high utilization of psychiatric services and low utilization of women's health services in transition-age youth with autism spectrum disorder may have implications for long-term health and warrants additional research.
Autism : the international journal of research and practice, 2021 · doi:10.1177/1362361320931268